Rehabilitation of gait after stroke: a review towards a top-down approach. J Neuro Eng Rehabil 8(1):66

Instituto de Biomecánica de Valencia, Universitat Politécnica de Valencia, Valencia, Spain.
Journal of NeuroEngineering and Rehabilitation (Impact Factor: 2.74). 12/2011; 8(1):66. DOI: 10.1186/1743-0003-8-66
Source: PubMed


This document provides a review of the techniques and therapies used in gait rehabilitation after stroke. It also examines the possible benefits of including assistive robotic devices and brain-computer interfaces in this field, according to a top-down approach, in which rehabilitation is driven by neural plasticity.
The methods reviewed comprise classical gait rehabilitation techniques (neurophysiological and motor learning approaches), functional electrical stimulation (FES), robotic devices, and brain-computer interfaces (BCI).
From the analysis of these approaches, we can draw the following conclusions. Regarding classical rehabilitation techniques, there is insufficient evidence to state that a particular approach is more effective in promoting gait recovery than other. Combination of different rehabilitation strategies seems to be more effective than over-ground gait training alone. Robotic devices need further research to show their suitability for walking training and their effects on over-ground gait. The use of FES combined with different walking retraining strategies has shown to result in improvements in hemiplegic gait. Reports on non-invasive BCIs for stroke recovery are limited to the rehabilitation of upper limbs; however, some works suggest that there might be a common mechanism which influences upper and lower limb recovery simultaneously, independently of the limb chosen for the rehabilitation therapy. Functional near infrared spectroscopy (fNIRS) enables researchers to detect signals from specific regions of the cortex during performance of motor activities for the development of future BCIs. Future research would make possible to analyze the impact of rehabilitation on brain plasticity, in order to adapt treatment resources to meet the needs of each patient and to optimize the recovery process.

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Available from: Juan Manuel Belda Lois
    • "Investigaciones recientes han comprobado que la precisa retroalimentación aferente (sensorial) proporcionada por la estimulación eléctrica de los nervios periféricos y los potenciales evocados por los mecanismos de planificación motora en M1 inducen la plasticidad cortical [10]. Estas investigaciones sugieren la posibilidad de proporcionar retroalimentación aferente para la mejora de la plasticidad cerebral. "

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    • "Robotic devices are increasingly investigated among researchers and are being used in the rehabilitation of physical impairments in both the upper and lower limbs [1] [2]. These devices provide safe, intensive and task-oriented rehabilitation for people with mild to severe motor impairments after neurologic injury. "

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    • "String-Man, developed by Fraunhofer IPK Institut. In spite of the many state-of-the-art studies that already exist [6], the scientific value of robotic approach is still limited [5]. "
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    ABSTRACT: Several studies have examined whether robotic devices can exceed conventional gait training in terms of long term rehabilitation outcomes. Most of the research reported on promising results and pointed out the advantages of rehabilitation robots over strenuous manual physiotherapy. We present a novel cognitive system for gait training that assessed human behavior with body sensors, electromyography, joint kinematics and utilizes smart algorithms to control the level of joint support in the gait orthosis. The powered orthosis was tested in a single healthy person and several gait cycles were compared with free treadmill walking. The analysis was carried out with an optical measurement system and electromyography. Very similar gait patterns confirmed that the orthosis does not hinder the natural movement of the person. Additionally the functionality of the automated assistance level was tested with a healthy person emulating the bilateral crouch gait on the treadmill. The outcomes suggested that the powered gait orthosis does not hinder natural treadmill base movement and the control sufficiently enables the voluntary contribution of the person. However, additional tests will be carried out in neuromuscularly impaired persons before the system will be ready for a proof of concept study.
    Full-text · Conference Paper · Aug 2015
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